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eComment: Vacuum-assisted closure in thoracic surgery – an alternative to pedicled latissimus dorsi flap?

Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany

Negative pressure dressing for radiation-associated wound dehiscence after posterolateral thoracotomy

I read with great interest the recent report from Dr. Welvaart et al. [1] regarding the use of the vacuum-assisted closure (VAC) system for wound healing by secondary intention. We agree with the authors that the use of negative pressure dressings is a valuable option in a given patient. As demonstrated vacuum-assisted closure is an option following mediastinitis with aortic arch replacement [2]. VAC is sought to prevent contamination of the wound without negative impact on cardiac hemodynamics in open chest and delayed sternal closure [3].

However, we would like to consider that this approach with eight weeks of VAC system with dressing changes by a home-based care nurse is not European-wide accessible. As far as Germany is concerned, the outpatient treatment with negative pressure dressing is rather hard to achieve as far as reimbursement with the health insurance is concerned. Given the illustration of the patient, a pedicled latissimus muscle flap [4] with or without a split-thickness skin graft might have been considered for defect closure in the radiated patient, too most probably without the long-lasting sequelae of eight weeks of VAC therapy.

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1. Welvaart WN, Oosterhuis JWA, Paul MA. Negative pressure dressing for radiation-associated wound dehiscence after posterolateral thoracotomy. Interact CardioVasc Thorac Surg 2009;8:558–560.[Abstract/Free Full Text]
2. Saiki Y, Kawamoto S, Sai S, Tabayashi K. An effective vacuum-assisted closure treatment for mediastinitis with aortic arch replacement. Interact CardioVasc Thorac Surg 2008;7:712–714.[Abstract/Free Full Text]
3. Fleck T, Kickinger B, Moidl R, Waldenberger F, Wolner E, Grabenwoger M, Wisser W. Management of open chest and delayed sternal closure with the vacuum assisted closure system: preliminary experience. Interact CardioVasc Thorac Surg 2008;7:801–804.[Abstract/Free Full Text]
4. Knobloch K, Gohritz A, Spies M, Vogt PM. eComment: Skin isle as a potential bronchoscopic monitoring isle in latissimus dorsi flap surgery for bronchus stump insufficiency. Interact CardioVasc Thorac Surg 2008;7:625.[Free Full Text]

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